There
are new ways to stop any side effects, to give less IVIg and
get better results based on cutting edge research by CIDPUSA.
By using subcutaneous IVIg. We know how to do to do that and
help a patient in 24 hours rather then wait months. You only infuse
1/10 of the dose.
What is IVIG
or Intra Venous Immunoglobulin
Below is copyright material. Help yourself try a effective
treatment in our e-book before IVIg
1. What is
IVIG or Intravenous Immune Globulin?
IVIg is a collection of antibodies called IgG.
IVIg is a plasma product formed by
taking antibodies from about 20,000 donors and mixing them
together. infusion of IVIg has proven effective in several immune
deficiency disorders, including nearly all autoimmune conditions
including CIDP and GBS.
The sooner you treat the patient with IVIg the better the results.
There is a short window of opportunity usually within the first 18
months after the diagnosis. Treatment with IVIg within the window
period is likely to halt the progress of the disease.
After being exposed to toxins and poisonous
chemicals including carbon monoxide the body's immune system may
mount a attack on the body. This autoimmune attack can be halted by
any anti-inflammatory treatment including IVIg.
2. How does
IVIG work?
IVIg is used in immune deficiency
where the body does not make enough antibodies, IVIG supplies
them. For autoimmune disorders like GBS & CIDP, there is a abnormal
antibody (autoantibody) being formed which is inactivated by IVIG.
Patients with autoimmune disorders like CIDP also
are deficient in antiidotype antibodies. IVIG supplies them.
Antiidotype antibodies are normal antibodies which are produced in
the absence of any antigen. They are capable of inactivating many
different types of antigens.
3. How long
does it take to a IVIG treatment to have a effect?
After IVIg is infused patients may see a response in
24- 48 hours. Some patients will have to wait 3-4 weeks to see an
effect. In a few no effect may be seen. If 4-5 cycles of IVIg do not
show any response then try a different approach like plasmapheresis,
cytotoxic, immune suppressants and antibiotics.
Everyone is slightly different as it depends on how
long has the disease process been going on. The sooner one treats it
the disease the faster the response.
4. Why is IVIG
so expensive?
IVIg is obtained from plasma donors
who are paid then the plasma is sent to a processing centers
for mixing, antibody removal, chemical treatment and filtration to
remove viruses. This is followed by the products to be
freeze dried. All this ends up for IVIG to be priced at $ 48 to $ 60
a gram (cost price of IVIg). A single infusion of IVIg may cost
about $3000 for a child to $10,000 for adults. For a child the cost
is lower as a small IVIg dose is used. If you have insurance you
will see the cost of infusion may go to 100,000.
The cost of IVIg in India & Pakistan $46 a gram,
lower prices are found in China where the manufacturer will see IVIg
for $10- a gram. This price has doubled in the last year, causing
CIDPUSA to shift towards recommending antibiotic treatment. The
antibiotic treatment may give faster results without any infusion
and cost $100.
5. How is IVIG
administered?
IVIG is mixed in a bag and a tube runs from it to a
vein usually in the arm. The recommended way to infuse includes a
pump. Usually IVIg is infused at a rate of 100 cc/ hour to 200 cc/
hour.
The rate of IVIg is reduced for any
problems such as headaches, rash, fatigue, hypertension or
hypotension. For an adult's IVIg infusion is usually given
over 5 to 6 hours. Dr Dalakas mentioned in his
study that precise control of IVIG infusion is required.
6. What are
the common side effects OF IVIG?
IVIg at times causes patients to get a
headache, which is more common in females with a history of
Migraines. after IVIg infusion some Patients may experience fatigue
similar to getting a Flu, which is due to antibodies interaction.
IVIg may also cause to patients get a rash and doctors
recommended they take Benadryl or even steroids to avoid this.
Remember their are a lot of antibodies and some may result in odd
reactions. Kidney failure may result after IVIg if less fluids are
given. Stroke or heart attack can happen after IVIg if the IVIg
solution is pumped in at a fast rate.
A severe headache with a stiff neck after IVIg may
be due to aseptic meningitis.
Variation in blood pressure, shortness of breath,
back pain can also be seen after IVIg infusion. Serious conditions
like encephalitis, myocarditis have been seen.
7. How can one
reduce the side effects of IVIG?
Remember to drink eight glasses of water a day for
hydration before starting the IVIg treatment and continuing this a
month after the last IVIg infusion. Some doctors recommend to take a
baby aspirin to prevent thrombophelebitis. Patients need to check
with their doctors if they can use aspirin and should not take
this if they are on coumadine or have bleeding disorders or if they
have a history of gastric ulcers. Doctors use Premedication
to help reduce side effects. Some recommend that one should take
Tylenol or other NSAID for prevention of headaches and pains. Use a
benadryl capsule for a rash and even to relax during the treatment.
Using low dose prednisone will reduce side effects like headaches.
8. Where is
the IVIG treatment given?
IVIg can be given at home, in a doctors clinic or a
hospital outpatient unit. Some patients have even taken IVIg at
work.
9. What is the
frequency of the IVIG treatment given?
Usually a IVIg dose of 2 grams per kilogram is
divided into five smaller doses of 400mg/kg, then this smaller dose
is infused daily for 5 days. This is followed by a monthly IVIg
infusion of 600mg/kg. Patients who have side effects can take
the IVIg treatment on alternate days. It is recommended that young
women take this IVIg on alternate days.
10. What are the
differences in brands of IVIG?
Generally the difference between brands of
IVIg is in the amount of IgA content and also if the IVIg contains
sucrose, glucose or some other sugar. Some IVIg products have
Glycine while another one has no preservatives.
Different IVIg products match different patients. In
general all the products work about the same. Some IVIg products
have a 5% concentration others can be made 10%. The concentration of
IVIg will make if thinner or thicker. CIDPUSA recommends a 5%
solution for intravenous and a higher concentration for
subcutaneous.
11. What is a
recall OF IVIG?
A recall of IVIg happens when someone reports
defects in IVIg, side effects of a particular batch of IVIg. Then
the FDA may issue a warning or a recall. This may also depend on
contamination.
A recall of IVIg may be followed by shortage of the
product in the market. Recently consumer demand for IVIg is
surpassing production.
12. Where can
I find out about recalls of IVIG?
The FDA in the US maintains a current
list of blood-product recalls on its site. This is because its
members use so many different types of blood products, and generally
store them in quantity. Look under Biologics and then recalls near
the middle of page.
http://www.fda.gov/cber/recalls.htm There you will find the IVIg
products which have been recalled. FDA also has a page for consumers
to report side effects of IVIg.
13. Who is a
good provider for IVIG?
There are many nationwide providers of IVIG. . Some
provide customized service for the patient. They select the
correct IVIG for the patient. They manage side effects Their nurses
are well trained. They will also work with you on CO-PAYS and
disease management. None of the providers should charge you a co-pay
in USA.
Email us for a good
provider in your area.
14. What is
the recommended dose as compared to age?
Children can tolerate a higher IVIg dose and the
whole 3g/kg dose has been given without side effects as a single
infusion. Young adults up to 25 years of age can tolerate
1g/kg of IVIg as a single infusion. Up to age 50 only 400mg/kg of
IVig is recommended in one day.
When dealing with above 70 year old patients we
recommend not to infuse more then 400mg/kg in one week. Yes a
higher dose of IVIg can be given but if the IVIg causes a stroke,
heart attack, fainting
then!
Please discuss above information with your doctor
and providers. The above recommendations of IVIg are based on my
experience and some of this is supported by current literature.
15. What is
the right IVIG product for me?
Patients need to understand the differences among the IVIg
products, and many factors need to be taken into consideration when
deciding which IVIG product should be prescribed. Some examples of
the factors include:
- Patients with congestive heart failure or compromised renal
function may fare better if they receive a IVIg product with a
low osmolality and low volume;
- Patients who are diabetic should receive a IVIg product
containing no sugars;
- Patients receiving IVIg products with sucrose may be at a
higher risk for renal failure;
- Patients with immunoglobulin A (IgA) deficiencies should
only receive products with the lowest amount of IgA or they
could have anaphylactic reactions. Of course there are safer
ways to infuse IVIg in IgA DEFICIENT PATIENTS. Hmm need to read
our E-Book.
- Patients with small peripheral vascular access or a tendency
toward phlebitis may want to avoid IVIg preparations with a low
pH.
16. I have no more veins
left and no central lines can be placed due to infections. How can I
get IVIg?
IVIg can be delivered by the subcutaneous route if venous access is
a problem. This is the preferred way of delivery for a immune
deficient patient.
CIDPUSA have found that subcutaneous IVIg as
a quicker and cheaper way to get better.
17. IVIG and
vaccination issue.
IVIG prevents vaccinations to take any effect in your body.
Immunizations should not be given for at least 1
month and preferably 3 months after a course of IVIG.
If on IVIg you do not need routine flu shots. As you
are getting the antibodies. (Check with your physician).
Alternatives to IVIg are
available and clinically proven. Please read our E-BOOK for detailed
information. For CIDPUSA by Dr Imran Khan MD Medical Director
Nanotech Neurology and Anti ageing treatment Clinics of
Excellence. Diplomate American
Academy of Neurology Psychiatry
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